REPUBLIC OF THE PHILIPPINES )

) S.S.

AFFIDAVIT
( With Undertaking of Liabilities)

I, ________________________, of legal age, Filipino, single/married/widow and a resident

of_________________________________________, after having sworn to in accordance with law,
hereby depose and state that:

1. I am the Lessor in the Contract of Lease with _______________________________under Site ID

No. ____________ involving a portion of my lot approximately measuring_____________
square meters, more or less, out of a total area of approximately ______________ square
meters, more or less, situated in __________________ and identified as Lot No. ________ and
declared for real property tax purposes under Tax Declaration No. __________________
covered by TCT No. ________________ issued by the Registry of Deeds for the Province of
_______________;

2. The said lot has an existing encumbrance of Real Estate Mortgage (REM) annotated at the back
of its TCT with ______________________ in the amount of
___________________________Pesos;

3. To date, my outstanding obligation is _________________Pesos, more or less, and I am in good

standing with my mortgagee/creditor;

4. I hereby undertake to regularly pay the mortgage amount to the mortgagee/creditor up to its
full satisfaction;

5. Further, I hereby undertake that construction of the cellsite will not be stopped and that in the
event of foreclosure, any improvements made by ___________________ shall remain to be the
property of _____________;

6. This undertaking is being executed to attest to the veracity of the foregoing and as requirement
for the purpose of granting _____________________________________ permission necessary
to acquire permits to commence installation of its facilities at the above-mentioned sites.

FURTHER AFFIANT SAYETH NAUGHT.

_____________________
Affiant

SUBSCRIBED AND SWORN to me this ___________ day of ___________, 2020, affiant

exhibiting me his Competent Evidence of Identity No.______________issued on
________________ at ___________________.

Notary Public
Doc. No. _____
Page No. _____
Book No. _____
Series of 2020